Stigma, Health Care Access, and HIV Knowledge Among MSM in Malawi, Namibia, and Botswana.

 AIDS Behav. 2010 Dec 10. [Epub ahead of print]

Fay H, Baral SD, Trapence G, Motimedi F, Umar E, Iipinge S, Dausab F, Wirtz A, Beyrer C.

Abstract

Same-sex practices are stigmatized in much of sub-Saharan Africa. Cross-sectional relationships between discrimination, access to and use of health care services, and HIV knowledge among men who have sex with men (MSM) were assessed in Malawi, Namibia, and Botswana. A survey and HIV screening were used to explore these variables and the prevalence of HIV. Overall, 19% of men screened positive for HIV infection. Ninety-three percent knew HIV is transmitted through anal sex with men, however, only 67% had ever received information of how to prevent this transmission. Few (17%) reported ever disclosing same sex practices to a health professional and 19% reported ever being afraid to seek health care. Men reported ever been denied health care services (5%) and 21% had ever been blackmailed because of their sexuality. Strong associations were observed between experiences of discrimination and fear of seeking health care services. Characterizing the relationship between stigma and health care seeking practices and attitudes can inform the development and implementation of HIV interventions for African MSM.

[Thanks to the Global Forum on MSM and HIV for putting this on our radar.]


[If an item is not written by an IRMA member, it should not be construed that IRMA has taken a position on the article's content, whether in support or in opposition.]

HIV Treatment for Refugees, but for How Long?

Via PlusNews

Until just over a year ago, people living in Dukwi, a remote refugee camp about 200km from Francistown, Botswana's second city, were burying other residents who had died from AIDS-related illnesses at the rate of about five a month. Botswana was the first country in southern Africa to roll out an antiretroviral (ARV) treatment programme, which now has almost universal coverage, but is among the last to include its relatively small refugee population.

For the full story click here.

BONELA calls for more same-sex information in AIDS campaigns (Botswana)

via Mmegi Online

Botswana Network on Ethics, Law and HIV/AIDS (BONELA) has requested that more HIV information about same sex relationships be incorporated in the general HIV interventions. Coordinator of BONELA Prevention Research and Initiative for Sexual Minorities (PRISM).

Felistus Motimedi (pictured) told the National AIDS Council last week that during a study BONELA conducted in 2008, it was discovered that there are men who are not necessarily gay, but have sex with other men. The study was meant to improve the understanding of HIV prevention, sexual behaviour and uptake of prevention services. Motimedi said that for some men, having sex with other men is not sexual orientation but a new behaviour pattern. Hence the need for new interventions on the prevention and treatment of HIV and related illnesses.

Motimedi said that they conducted a study in Gaborone, with a population of only 200 as a result of financial constraints. They found information which is at least a starting point and identifies an issue which calls for further studies. "These were men who had identified themselves as men who have had sex with other men," she said.

Motimedi said that during the study, 90.6% reported having received information on how to prevent getting HIV from a woman, while only 50.4% indicated having received information on how to prevent getting the virus from other men. "This is proof that there are not enough messages on same sex prevention campaigns hence we call for immediate interventions," she said.

Motimedi stated that it is important that lubrication be incorporated in campaigns together with condoms since anal sex does not have enough bodily secretion that could enhance safe sex. "They said that they use petroleum jelly or vaseline, body creams or fatty creams, water based lubricants and saliva as lubricants during sex and we all know these are not safe to use," she said. Motimedi called for promotion of condom use and lubrication and education for men who have sex with other men.  She urged various stakeholders to take note of emerging needs and issues of men who have sex with other men.

Motimedi said that during the study, it was revealed that a majority of men having sex with other men are in the 20-29 age group and HIV prevalence is highest in the 25-29 age group.

"Therefore we are saying that young males need focused interventions and sex education to avoid HIV infections through intergenerational sex," she said.

HIV Prevalence, Risks for HIV Infection, and Human Rights among MSM in Malawi, Namibia, and Botswana

In the generalized epidemics of HIV in southern Sub-Saharan Africa, men who have sex with men have been largely excluded from HIV surveillance and research. Epidemiologic data for MSM in southern Africa are among the sparsest globally, and HIV risk among these men has yet to be characterized in the majority of countries.

via PLoS ONE, by:

Stefan Baral^1,7*, Gift Trapence², Felistus Motimedi³, Eric Umar⁴, Scholastika Iipinge⁵, Friedel Dausab⁶, Chris Beyrer¹

1 Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland, United States of America, 2 Center for the Development of People, Blantyre, Malawi, 3 Botswana Network on Ethics, Law, and HIV/AIDS, Gaborone, Botswana, 4 Department of Community Health, University of Malawi,-College of Medicine, Blantyre, Malawi, 5 HIV/AIDS Coordinator, University of Namibia, Windhoek, Namibia, 6 The Rainbow Project, Windhoek, Namibia, 7 Department of Public Health Sciences, University of Toronto, Toronto, Ontario, Canada

INTRO:

While southern Sub-Saharan Africa has long been the most HIV/AIDS affected region globally, it has been arguably the most understudied for the risk of HIV associated with male to male sexual contact The crude characterization of these epidemics as generalized and driven by heterosexual risks has obscured the component of Southern Africa's epidemics which may be due to risks among men who have sex with men (MSM). The marked homophobia, discrimination, and criminalization of same-sex behavior in much of Africa have likely limited investigation among these men. Data regarding the prevalence of MSM in the region are among the sparsest globally, but there is evidence that male to male sexual contact is a reality on this continent as on all others To date, there have been published papers from only Senegal and Kenya describing HIV risk and prevalence among MSM in Africa . However, a systematic review found studies from other African countries either not presenting HIV prevalence data or studies that to-date have only been presented as abstracts. These studies suggest that African MSM are at substantial risk for HIV infection, and that they have been markedly underserved and marginalized. Reported HIV rates, where available, have been higher than among other men of reproductive age in the same populations, yet these men tend to have limited knowledge of the health related risks of anal intercourse. The lack of data on MSM and HIV are paradoxically the most marked for the world's highest prevalence zone; the southern region of Sub-Saharan Africa. No published studies have reported HIV prevalence among MSM in Namibia, Malawi, and Botswana, three profoundly HIV/AIDS affected southern states. MSM have not been included in the HIV/AIDS strategies in these countries and same sex behavior among consenting adults is criminalized in all three states in 2008.

Read the entire article on PLoS One.

Increased visibility: more light shed on MSM in Africa and India

via Aidsmap

The majority of men who have sex with men (MSM) in three different African countries and in Tamil Nadu State in India also have sex with women, according to two presentations and a poster at the CROI Conference in Montreal.

In Tamil Nadu, HIV prevalence is substantially higher in MSM than the general population and they could serve as a ‘bridge’ for HIV transmission between minority communities and women, researchers found.

In Africa, in the first-ever surveys of their kind, researchers uncovered communities of men with high levels of HIV risk behaviour, including injecting drug use. They found that the already-noted tendency in Africa to have long-term concurrent relationships with more than one partner – one explanation advanced for the high HIV prevalence there – was the same for MSM, with a high proportion of men engaging in ‘bisexually concurrent’ relationships.

Three African countries Chris Beyrer of the Center for Public Health and Human Rights at the Johns Hopkins School of Medicine in Baltimore presented updated findings from a programme of surveys of MSM and HIV in a number of African countries. Preliminary findings from the first of these surveys in Malawi were presented at the pre-World AIDS Conference satellite meeting in Mexico City last year – see this report. Beyrer added data from Namibia and Botswana – other surveys are ongoing in Nigeria and South Africa.

In most of these countries there has hitherto been literally no data on MSM, Beyrer said. Male/male sex is illegal and stigmatised, and until recently surveys of MSM would have been impossible. Recently, however, health ministries in some African countries have become more supportive of research and prevention work among this community and local non-governmental and community organisations have been willing to act as local hosts for the research programme.

Read the rest.